The Use of Flexible Bronchoscope for Diagnostic Medical Thoracoscopy in a Resource-Limited Setting: A Retrospective Study

Kaushil, Rajnish; Dahiya, Roopali; Chaudhry, Aditya; Singh, Pawan Kumar; Ahuja, Aman K; Chaudhry, Dhruva; Arya, Geetika

The Use of Flexible Bronchoscope for Diagnostic Medical Thoracoscopy in a Resource-Limited Setting: A Retrospective Study

Document Type : Original Article

Authors

Rajnish Kaushil ¹

Roopali Dahiya ²

Aditya Chaudhry ³

Pawan Kumar Singh ⁴

Aman K Ahuja ⁵

Dhruva Chaudhry ⁵

Geetika Arya ⁶

¹ Department of Pulmonary Medicine, VMMC and Safdarjung Hospital, New Delhi, India

² Department of Medicine, Dr RML PGIMER, New Delhi, India

³ Department of Medicine, KCGMC, Karnal, India

⁴ Department of Pulmonary and Critical Care Medicine, Pt B.D. Sharma PGIMS, Rohtak

⁵ Department of Pulmonary and Critical Care Medicine, Pt B.D. Sharma PGIMS, Rohtak, India

⁶ Department of Anatomy, Pt B.D. Sharma PGIMS, Rohtak

Abstract

Background: Exudative pleural effusion (ePE) is a common presentation in pulmonology clinics. Pleural biopsy is indicated for identifying the etiology in undiagnosed ePE, especially those with low adenosine-deaminase levels. Access to rigid and semi-rigid medical thoracoscopy is scarce and heterogeneous in a resource-limited country like India. In such circumstances, using a flexible bronchoscope via an intercostal chest tube for visualization of the parietal pleura and pleural biopsy offers a way out.
Materials and Methods: In this retrospective study, we have presented our experience of such practice on 25 cases. Mean age was 52.4±1 years. Adhesions were present in 40% of the subjects.
Results: The most common finding was the presence of nodules. On average, 6.8 passes were taken with a maximum of 10. In 32% cases, only tiny tissue was obtained, hence requiring multiple passes. Large tissue could be obtained in 44% of the subjects. The mean duration of the procedure was 35.6±9.0 minutes. Tissue diagnosis was established in 80% with the most common being malignancy (48%), followed by tuberculosis (20%). In 3 cases, the final diagnosis was made by exclusion. No major complications were recorded.
Conclusions: In conclusion, medical thoracoscopy using a flexible video bronchoscope via intercostal chest tube was a feasible alternative for the diagnosis of ePE effusion in resource-limited settings.

Keywords

Bronchoscope

Medical Thoracoscopy

Tuberculosis

Pleural Effusion

Malignant Pleural Effusion

Subjects